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1144847260 NPI number — PARKROSE VISION, LLC

NPI Number: 1144847260
Health Care Provider/Practitioner: PARKROSE VISION, LLC

Information about “1144847260” NPI (PARKROSE VISION, LLC) exists in 1144847260 in HTML format HTML  |  1144847260 in plain Text format TXT  |  1144847260 in PDF (Portable Document Format) PDF  |  1144847260 in an XML format XML  formats.

NPI Number : 1144847260 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1144847260",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "M. KWON. P.C., INC.",
    "ParentOrgTIN": null,
    "OrgName": "PARKROSE VISION, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "15470 SE BADEN POWELL RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HAPPY VALLEY",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97086-6049",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "503-819-1807",
    "MailingAddressFaxNumber": "503-432-8402",
    "FirstLinePracticeLocationAddress": "4880 NE 104TH AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PORTLAND",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97220",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "503-943-0699",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/06/2020",
    "LastUpdateDate": "05/22/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KIM",
    "AuthorizedOfficialFirstName": "HALEY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "OD",
    "AuthorizedOfficialTelephoneNumber": "503-432-8452",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261Q00000X",
        "TaxonomyName": "Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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